Care Managers’ Time Use: Differences Between Community Mental Health and Older People’s Services in the United Kingdom

Abstract

Since the community care reforms of the early 1990s, care management in the United Kingdom has become the usual means of arranging services for even the most straightforward of social care needs. This paper presents data from a diary study of care managers' time use, from a sample of social services commissioning organizations representing the most common forms of care management practiced in England at the end of the 20th century. It compares the working practices of care managers in community mental health service settings to the practices of those situated in older people's services. Evidence is provided to suggest that while the former follow a more clinical model of care management, those working with older people take an almost exclusively administrative approach to their work. In addition, the multidisciplinary nature of mental health service teams appears to facilitate a more integrated health and social care approach to care management compared to the approach to older people's services. Further enquiry is needed as to the comparative effectiveness of these different modes of working in each service setting.

Care management for older people with mental health problems: from evidence to practice

“…It would have been desirable to have captured the characteristics of respondents and non-respondents, but the study team was advised that collecting personal information about respondents would be likely to decrease the response rate. Caution should be exercised in generalising the study's findings therefore, although, interestingly, the results are not greatly different from those reported in other work that has utilised a similar classification, [39][40][41][42]76 while the mix of services for older people with mental Models of Care health problems in the study area appeared typical of services nationwide. 34 At least some data were recorded retrospectively, as the pressures of work obliged busy practitioners to wait until the day' s end before completing schedules.…”

“…All social workers, social care workers, community mental health nurses (CMHNs) and community support workers who primarily worked with older people were asked to complete a specially designed diary schedule adapted from previous research [39][40][41][42] to reflect local practice on each working day within a 1-week period in April/May 2004. This involved inserting a code for the activity in which they had been predominantly engaged for each 30-minute period from a list of 45 activities.…”

“…However, this framework has been used successfully in old age, adult mental health and old age mental health services previously. [39][40][41][42] The diary schedules were distributed to practitioners via team leaders. Although all the CMHNs for older people by definition predominantly worked with older people, there was no precise information on the number of social services staff who did so, and managers therefore left individual practitioners to determine whether their caseloads fulfilled these criteria.…”

Mental health nurses’ contributions to community mental health care: An Australian study

“…However, this assistance was mostly unable to be reciprocated due to the nursing specific interventions required (Cosgrave et al ). While the internal coordination of care role has previously been documented in nursing literature, the findings of this study will assist services to quantify this role and to determine the number of nursing full time equivalent community appointments required by the service (Burnard et al ; Henderson et al ; Jacobs et al ). The need for further research to compare workload allocation and complexity of CMHNs with other community mental health professionals is also apparent to the ongoing composition of effective community teams.…”

Exploring patterns of care coordination within services for older people

“…Previous research studies have suggested that an administrative type of care coordination for the purpose of providing information and advice in the short-term predominates in England. 32,38,39 Joint working between health and social care. A lack of service integration has been associated with fragmented poorly coordinated services at the level of the individual, with delays or failure of service delivery.…”